Nov

21

Copper: The Bacteria-Fighting Super Element is Making a Comeback In Hospitals

This is human coronavirus 229E being inactivated on copper. Credit: University of Southampton, England

Copper is being embraced by some hospitals because of its ability to kill 1) ___ and other microbes on contact, which can help reduce deadly infections. Copper can kill or inactivate a variety of pathogens by interacting with oxygen and modifying oxygen molecules. In bacteria, this disrupts the outer layer, damaging the genetic material and cell machinery, which can lead to cell death. A recent study found that copper also destroys norovirus. There has been only one published clinical trial showing how copper reduces infections in hospitals. The results, however, were striking. The study, which took place between July 2010 and June 2011, showed that copper surfaces reduced infection rates by 58%. The antimicrobial effect of copper-alloy surfaces is a result of the metal stealing electrons from the bacteria when they come into contact with each other. Once the bacteria donate the electrons to the copper metal, this places the organism into a state of electrical-charge deficit. As a consequence, free radicals are generated inside the cell, which ultimately leads to the cell’s death.

Checking into a hospital can boost your chances of infection. That’s a disturbing paradox of modern medical care. And it doesn’t matter where in the world you’re hospitalized. From the finest to the most rudimentary medical facilities, patients are vulnerable to new 2) ___ that have nothing to do with their original medical problem. These are referred to as healthcare-acquired infections, healthcare-associated infections or hospital-acquired infections. These are infections like pneumonia and urinary tract infections. Many of them, like methicillin-resistant Staphylococcus aureus (MRSA), can be deadly. The World Health Organization estimates that each year, hundreds of millions of patients around the world are affected by healthcare-acquired infections. In the United States, the Office of Disease Prevention and Health Promotion in the Health and Human Services Department estimates that 1 in 25 inpatients has a 3) ___-related infection. In developing countries, estimates run higher.

Hospital bed safety railings are a major source of these infections. That’s what Constanza Correa, 33, and her colleagues have found in their research in Santiago, Chile. They’ve taken on the problem by replacing them, since 2013, with railings made of copper, an anti-microbial element. Copper definitely wipes out 4) ___. Bacteria, yeasts and viruses are rapidly killed on metallic copper surfaces, and the term contact killing has been coined for this process, wrote the authors of an article on copper in Applied and Environmental Microbiology. That knowledge has been around a very long time. The journal article cites an Egyptian medical text, written around 2600-2000 BCE, that cites the use of copper to sterilize chest wounds and drinking water. Correa’s startup, Copper BioHealth, has not yet assessed the railings’ impact in Chilean hospitals. But a study of the effects of copper-alloy surfaces in U.S. hospitals’ intensive care units, published last year in Infection Control and Hospital Epidemiology, showed promising results: Their presence reduced the number of healthcare-acquired infections from 8.1% in regular rooms to 3.4% in the copper rooms.

Healthcare-acquired infections are a huge problem. People come to the hospital with a sickness, and they get another one in the hospital. Then they have to stay longer and spend more money on treatment. Sometimes it can cause 5) ___. Eighty percent of these infections come from touching hospital surfaces. In the hospital room, the most contaminated surface is the bed rail. It’s the most manipulated by medical staff and patients. It’s in direct contact with the patient. That’s the most critical surface in the room. A hospital’s objective is to decrease the chance of infection due to surface contact. So if we can replace current bed rails with copper bed rails, there is the potential to kill viruses, fungi and bacteria continuously. The magnitude of the problem is that in industrialized countries, 5% of patients develop these infections and the number is three times more in developing countries. In the United States, the annual direct cost to treat these infections is $40 billion a year. At least 15 hospitals across the country have installed, or are considering installing, copper components on high-touch surfaces easily contaminated with microbes – faucet handles on sinks, cabinet pulls, toilet levers, call buttons and IV poles. We’ve known for a long time that copper and other metals are effective in killing microbes, so it wasn’t a great leap to incorporate copper surfaces into hospitals, said John Lynch, medical director of infection control at Seattle’s Harborview Medical Center, which is redesigning a waste-disposal room to incorporate copper on light switches and door handles. For many hospitals, the death of Ebola patient Thomas Eric Duncan last year at a Dallas hospital heightened concerns – two nurses caring for him caught the 6) ___ because of poor infection control. And even before that, public health officials had identified nearly two dozen dangerous pathogens – many of them resistant to virtually all antibiotics – whose spread in health facilities and elsewhere could result in potentially catastrophic consequences. They include MRSA, a potentially deadly infection that is increasing in community settings; VRE, which can cause a variety of infections; and C. diff, which causes life-threatening diarrhea and sends 250,000 people to the hospital every year.

On any given day, about 1 in 25 patients in acute-care hospitals has at least one health-care-associated infection, according to the CDC or 7) ___ for ___ ___ and ___. Pneumonia and surgical-site infections are among the most common. In 2011, about 75,000 patients with health-care-associated infections died in the hospital. Hospital officials aren’t the only ones interested in copper. Hartsfield-Jackson Atlanta International Airport installed drinking fountains retrofitted with antimicrobial copper surfaces. In Colorado Springs, the U.S. Olympic Committee’s flagship training center uses custom dumbbells with antimicrobial copper grips. So do two professional hockey teams, the Los Angeles Kings and St. Louis Blues. Even a Chick-fil-A in Morganton, N.C., installed antimicrobial copper on restroom door handles.

Now, the CDC is pressing for more research. Recently, it held a roundtable on environmental infection control in preventing Ebola and other health-care-associated infections. Officials, who are exploring copper and other technologies, are working with hospitals, academics and the copper industry. The Defense Department, which funded the first clinical trial on copper and hospital-acquired infections, is researching copper’s effectiveness against one type of bacteria, acinetobacter, which can cause pneumonia or bloodstream infections among critically ill patients, including wounded 8) ___ returning from the battlefield. Many experts have concluded that traditional methods for reducing hospital-acquired infections, such as hand washing, aren’t enough, because people don’t always do what they are supposed to do and many pathogens can survive for long periods on surfaces. That’s why hospitals are experimenting with other ways to destroy them, including using ultraviolet light and hydrogen peroxide vapor to target germs in nooks and crannies not easily reached by cleaning crews. But those measures require actions by human beings – which is not the case with copper. It’s always working, it requires no human intervention, no supervision, and it’s acting continuously, said Michael Schmidt, a microbiology professor at the Medical University of South Carolina and one of the researchers who conducted the first and largest study of copper surfaces in hospitals. Besides the South Carolina hospital, the study involved Memorial Sloan Kettering Cancer Center in New York and the Veterans Affairs hospital in Charleston, S.C. About 600 patients who were admitted to the intensive-care units at the facilities were randomly assigned to receive care in traditional patient rooms or ones in which six frequently touched objects – such as bed rails, tables, IV poles and nurse call buttons – were made from copper alloys. While welcoming the findings, researchers said additional studies are needed to answer many questions. Is there a minimal risk number out there – how many bacteria on a surface to really put people at risk? said L. Clifford McDonald, a medical epidemiologist at the CDC. Right now, there’s not enough data on copper or other technologies to make firm recommendations on what hospitals should do, he said. In the meantime, facilities should continue to thoroughly clean patients’ rooms and supplement that with disinfectants. And everyone, especially health-care workers, should wash their hands with soap and water.

At an American Hospital Association conference in July, Todd Linden, chief executive of Grinnell Regional Medical Center in Iowa, gave a 70-minute presentation on copper items installed in 13 of the hospital’s patient rooms. The 49-bed facility also plans to use copper in renovating its emergency room. Grinnell College biology professor Shannon Hinsa-Leasure is conducting a clinical trial on the hospital’s use of copper. The hospital’s fitness center also has copper components, including on its free weights. Olin Brass and its manufacturing partners donated products for the hospital; community donations paid for the fitness center. A typical U.S. hospital room contains about $100,000 of goods and equipment, experts say. The average cost to outfit a hospital room with antimicrobial copper items is about $5,000, Linden said. But one infection adds $43,000 in patient costs, according to federal data. And under the Affordable Care Act, hospitals with higher infection rates and other patient injuries face decreases in their Medicare reimbursements.

The copper industry, meanwhile, provided financial help to several facilities interested in experimenting with 9) ___surfaces. The Copper Development Association gave $50,000 in grants to four hospitals in 2013 and 2014, said Adam Estelle, a project engineer with the trade group. The association began promoting copper’s antimicrobial properties in 2008, when several groups of copper products met standards of the Environmental Protection Agency to be registered as antimicrobial and effective in killing six types of bacteria, including MRSA, VRE and the deadly E. coli 0157 strain, the culprit in numerous food recalls, illnesses and deaths. Pullman Regional Hospital in Washington State received a $10,000 grant from the copper industry group two years ago. The 26-bed hospital bought more than 1,200 cabinet drawer pulls and 22 handicapped-access buttons on doors. Ed Harrich, chief of surgical services, and his staff have been methodically installing the hardware. He persuaded hospital administrators to approve another $10,000 for more items. More than 150 health-care and other facilities have installed antimicrobial copper alloy surfaces manufactured in the U.S. since 2011, according to the Copper Development Association. Cost is an issue. Adding copper surfaces is about 15 to 20% more expensive than using traditional stainless steel. But the long-term 10) ___are worth it. Sources: The Washington Post, Wall Street Journal, NPR; Medscape; ScienceDaily